1. Adham Abu Taha, PhD Dept. of Pharmacology and Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine Antimicrobial resistance among bacterial pathogens isolated from UTIs

2. Introduction  Among the 10 leading causes of death, infections are considered the number one in the low income countries and the fourth killer in the developed countries.  Most of the infections are caused by bacteria  Antibiotics are the only drugs for these bacterial diseases

3. Urinary Tract Infection (UTI) is the most common infectious diseases diagnosed in outpatients. Reporting of antimicrobial susceptibility testing is usually achieved in 48 h.

4. The treatment decision is empirical, being influenced by available data reflecting antibiotic resistance. Knowledge of the antimicrobial resistance patterns of common uropathogens is essential to provide clinically appropriate and cost effective therapy.

5. Aims of study 1.To determine the frequency of the uropathogens 2.To determine the susceptibility of these isolates to commonly used and newer antimicrobial agents.

6. A prospective study was conducted on bacteria isolated from the urine of patients with UTI in the city of Nablus, Palestine.

7. Specimens: 375 Females Males 81.6 % 18.4% Males: 69 Females: 306 Results

8. Which Bacteria ?

9. Frequency of uropathogens Gram negative MicroorganismNumber% E. coli24364.8 Pseudomonas aeruginosa 5114.4 Proteus mirabilis275.6 Klebsiella spp.123.2 Enterobacter spp.152.4 Gram positive S. aureus123.2 S.saprophyticus215.6 Enterococcus spp.30.8 Total number375100

10. Gender Microorganism Females n=306 Males n=69 E. coli192 (62.7%)51(73.9%) Klebsiella spp.12 (3.9%)0 Pseudomonas48 (15.7%)6 (8.7%) Enterobacter spp.9 (2.9%)0 Proteus mirabilis18 (5.9%)3 (4.3%) S. aureus6 (2.0%)6 (8.7%( Enterococcus3 (1%)0 S.saprophyticus18 (5.9%)3 (4.3%) Distribution of uropathogens

11. ampicillin (AMP), Amoxicillin-clavulinic acid (AMC), trimethoprim-sulfamthoxazole (TMP-SXT), nitofurantoin (F), ciprofloxacin (CIP), gentamycin (CN), cefataxime (CTX), ceftriaxone (CRO), naladixic acid (NA), and tetracycline (TE) Antibiotic Resistance ( %) TMP-SXT37 F29.6 AMP65.4 NA37 CIP17.2 AMC12.3 CTX11.1 CRO 11.1 TE 55.6 CN 14.8 Antibiotics resistance of E. coli

12. Antimicrobial resistance (%) of E. coli in selected countries USA 4 Israel 3 Turkey 2 S. Gaza 1 Nablus 37ND49.1ND65.4AMP 16.12641.571.437TMP-SXT 0.718.87.129.6F 2.5ND24.515.017.2CIP Ampicillin (AMP), trimethoprim-sulfamthoxazole (TMP-SXT), nitrofurantoin (F), ciprofloxacin (CIP), not done (ND) 1 Astal, et al, J Biomed Biotechnol. 2005; 2005(3): 238–241 2Kurtuepe et al, Jpn. Jornal of infect. Dis 58, 159 – 161, 2005 3Colodher et al, I. J. of Antimicrobial agents, 8, 189 – 192, (2001) 4Karl Lowsky et al, Antimicrobial agents and chemotherapy, 2540n- 2545, (2002)

13. Antibiotic use in Palestine Antibiotics were the most commonly prescribed medications

14. Types of stored medications Palestinian households Drug Classification (ATC system) Total N=5505 % Alimentary tract and metabolism102018.53 Musculoskeletal system78314.2 Respiratory system74913.6 Anti-infective agents for systemic use64111.6 Nervous system63211.5 Dermatologicals4778.7 Cardiovascular system4107.4 Blood and blood forming organs2674.9 Sensory organs2654.8 Genito urinary system and sex hormones961.7 Int J Clin Pharmacol Ther. 2010 Jan;48(1):59-67. Storage, utilization and cost of drug products in Palestinian households. Sweileh WMSweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Bani Shamseh FF, Khalaf HS.Sawalha AFZyoud SHAl-Jabi SWBani Shamseh FFKhalaf HS

17. Spread of antibiotic resistance Superbug

18. Recommendations 1.Surveillance program of antibiotic resistance 2.Local guidelines 3.Responsible use of antibiotics

19. Acknowledgment Mr. Jum ’ a Hashash- Nablus medical supplies Mr. Fadi Sulieman

20. Help prevent antibioticresistance Thank You